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| Plan Name | LEVEL ONE SURGICAL SPECIALISTS, P.C. RETIREMENT SAVINGS PLAN |
| Plan identification number | 001 |
| 401k Plan Type | Defined Contribution Pension |
| Plan Features/Benefits |
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| Company Name: | LEVEL ONE SURGICAL SPECIALISTS, PC |
| Employer identification number (EIN): | 311499285 |
| NAIC Classification: | 621111 |
| NAIC Description: | Offices of Physicians (except Mental Health Specialists) |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 001 | 2020-01-01 | RANDY JANCZYK | 2021-10-01 | RANDY JANCZYK | 2021-10-01 |
| 001 | 2019-01-01 | RANDY JANCZYK | 2020-07-13 | RANDY JANCZYK | 2020-07-13 |
| 001 | 2018-01-01 | RANDY JANCZYK | 2019-10-08 | RANDY JANCZYK | 2019-10-08 |
| 001 | 2017-01-01 | RANDY JANCZYK | 2018-05-19 | RANDY JANCZYK | 2018-05-19 |
| 001 | 2016-01-01 | RANDY JANCZYK | 2017-07-25 | RANDY JANCZYK | 2017-07-25 |
| 001 | 2016-01-01 | RANDY JANCZYK | 2017-11-15 | RANDY JANCZYK | 2017-11-15 |
| 001 | 2015-01-01 | RANDY JANCZYK | 2016-07-25 | RANDY JANCZYK | 2016-07-25 |
| 001 | 2014-01-01 | RANDY JANCZYK | 2015-10-15 | RANDY JANCZYK | 2015-10-15 |
| 001 | 2013-01-01 | RANDY JANCZYK | 2014-10-06 | ||
| 001 | 2012-01-01 | RANDY JANCZYK | 2013-10-04 | ||
| 001 | 2011-01-01 | RANDY JANCZYK | 2012-10-09 | ||
| 001 | 2010-01-01 | RANDY JANCZYK | GREG HOWELLS | 2011-06-13 | |
| 001 | 2009-01-01 | RANDY JANCZYK | GREG HOWELLS | 2010-06-23 |
| Measure | Date | Value |
|---|---|---|
| 2010: LEVEL ONE SURGICAL SPECIALISTS, P.C. RETIREMENT SAVINGS PLAN 2010 401k membership | ||
| Total participants, beginning-of-year | 2010-01-01 | 3 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 3 |
| Total of all active and inactive participants | 2010-01-01 | 3 |
| Total participants | 2010-01-01 | 3 |
| Number of participants with account balances | 2010-01-01 | 3 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2010-01-01 | 0 |
| 2009: LEVEL ONE SURGICAL SPECIALISTS, P.C. RETIREMENT SAVINGS PLAN 2009 401k membership | ||
| Total participants, beginning-of-year | 2009-01-01 | 3 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 3 |
| Total of all active and inactive participants | 2009-01-01 | 3 |
| Total participants | 2009-01-01 | 3 |
| Number of participants with account balances | 2009-01-01 | 3 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2009-01-01 | 0 |
| Measure | Date | Value |
|---|---|---|
| 2010 : LEVEL ONE SURGICAL SPECIALISTS, P.C. RETIREMENT SAVINGS PLAN 2010 401k financial data | ||
| Total income from all sources | 2010-12-31 | $495,453 |
| Expenses. Total of all expenses incurred | 2010-12-31 | $19,116 |
| Total plan assets at end of year | 2010-12-31 | $2,790,686 |
| Total plan assets at beginning of year | 2010-12-31 | $2,314,349 |
| Value of fidelity bond covering the plan | 2010-12-31 | $250,000 |
| Total contributions received or receivable from participants | 2010-12-31 | $12,400 |
| Expenses. Other expenses not covered elsewhere | 2010-12-31 | $598 |
| Other income received | 2010-12-31 | $403,053 |
| Net income (gross income less expenses) | 2010-12-31 | $476,337 |
| Net plan assets at end of year (total assets less liabilities) | 2010-12-31 | $2,790,686 |
| Net plan assets at beginning of year (total assets less liabilities) | 2010-12-31 | $2,314,349 |
| Total contributions received or receivable from employer(s) | 2010-12-31 | $80,000 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2010-12-31 | $18,518 |
| 2010: LEVEL ONE SURGICAL SPECIALISTS, P.C. RETIREMENT SAVINGS PLAN 2010 form 5500 responses | ||
|---|---|---|
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | Submission has been amended | No |
| 2010-01-01 | This submission is the final filing | No |
| 2010-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-01-01 | Plan is a collectively bargained plan | No |
| 2010-01-01 | Plan funding arrangement – Trust | Yes |
| 2010-01-01 | Plan benefit arrangement - Trust | Yes |
| 2009: LEVEL ONE SURGICAL SPECIALISTS, P.C. RETIREMENT SAVINGS PLAN 2009 form 5500 responses | ||
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | Submission has been amended | No |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-01-01 | Plan is a collectively bargained plan | No |
| 2009-01-01 | Plan funding arrangement – Trust | Yes |
| 2009-01-01 | Plan benefit arrangement - Trust | Yes |
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